Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH.
Department of HPB Surgery and Liver Transplantation, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH.
Ann Surg. 2023 Dec 1;278(6):961-968. doi: 10.1097/SLA.0000000000006041. Epub 2023 Jul 21.
To compare the effect of liver transplantation (LT) on ileal pouch-anal anastomosis (IPAA) outcomes in patients with primary sclerosing cholangitis and inflammatory bowel disease (PSC-IBD).
Patients with PSC-IBD may require both IPAA for colitis and LT for PSC.
Patients with PSC-IBD from out institutional pouch registry (1985-2022) were divided according to LT status and timing of LT (before and after IPAA) and their outcomes analyzed.
A total of 160 patients were included: 112 (70%) nontransplanted at last follow-up; 48 (30%) transplanted, of which 23 (14%) before IPAA and 25 (16%) after. Nontransplanted patients at IPAA had more laparoscopic procedures [37 (46%) vs 8 (18%), P =0.002] and less blood loss (median 250 vs 400 mL, P =0.006). Morbidity and mortality at 90 days were similar. Chronic pouchitis was higher in transplanted compared with nontransplanted patients [32 (67%) vs 51 (45.5%), P =0.03], but nontransplanted patients had a higher rate of chronic antibiotic refractory pouchitis. Overall survival was similar, but nontransplanted patients had more PSC-related deaths (12.5% vs 2%, P =0.002). Pouch survival at 10 years was 90% for nontransplanted patients and 100% for transplanted patients (log-rank P =0.052). Timing of LT had no impact on chronic pouchitis, pouch failure, or overall survival. PSC recurrence was 6% at 10 years. For transplanted patients, graft survival was similar regardless of IPAA timing.
In patients with PSC-IBD and IPAA, LT is linked to an increased pouchitis rate but does not affect overall and pouch survival. Timing of LT does not influence short-term and long-term pouch outcomes.
比较肝移植（LT）对原发性硬化性胆管炎和炎症性肠病（PSC-IBD）患者回肠储袋肛门吻合术（IPAA）结局的影响。
PSC-IBD 患者可能需要同时进行 IPAA 以治疗结肠炎和 LT 以治疗 PSC。
根据 LT 状态和 LT 时机（IPAA 前后），将来自我们机构储袋登记处（1985-2022 年）的 PSC-IBD 患者分为两组，并分析其结局。
共纳入 160 例患者：112 例（70%）在最后一次随访时未接受移植；48 例（30%）接受了移植，其中 23 例（14%）在 IPAA 之前，25 例（16%）在 IPAA 之后。在接受 IPAA 的未接受移植的患者中，腹腔镜手术更多[37（46%）vs 8（18%），P=0.002]，出血量更少（中位数 250 与 400ml，P=0.006）。90 天的发病率和死亡率相似。与未接受移植的患者相比，接受移植的患者慢性储袋炎的发生率更高[32（67%）vs 51（45.5%），P=0.03]，但未接受移植的患者慢性抗生素难治性储袋炎的发生率更高。总体生存率相似，但未接受移植的患者 PSC 相关死亡率更高（12.5% vs 2%，P=0.002）。10 年时，未接受移植患者的储袋生存率为 90%，接受移植患者的储袋生存率为 100%（对数秩 P=0.052）。LT 的时机对慢性储袋炎、储袋失败或总体生存率均无影响。10 年时 PSC 复发率为 6%。对于接受移植的患者，无论 IPAA 的时机如何，移植物的存活率均相似。
在 PSC-IBD 和 IPAA 患者中，LT 与储袋炎发生率增加相关，但不影响总体生存率和储袋生存率。LT 的时机不影响短期和长期储袋结局。
